Aspect of Reimbursement
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First, we would like to congratulate the authors for their article which is definitely worth regarding (1). However, recent developments in 2018 should be mentioned with regard to the reimbursement of extracorporeal shockwave therapy (ESWT) by the German statutory health insurances (Gesetzliche Krankenkassen, GKV).
On 19 April 2018, the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) in Berlin listed ESWT for heel pain as an outpatient treatment option after reviewing the method. In the future, the statutory health insurances (GKV) will pay for the use of ESWT to treat patients whose usual physical activity has been impaired by heel pain for more than six months, provided that during this period various conservative treatment strategies, such as stretching exercises and insoles, have been applied without achieving relevant relief. In a double-blind, randomized controlled trial, high-energy focused ESWT (electromagnetic 0.25 mJ/mm2, 2000 pulses, 3 sessions) significantly reduced the pain (69% versus 34.5%) (2). High-energy shockwave therapy was found to be superior to steroid injections in a meta-analysis including 9 randomized controlled trials (evidence level 1A ) (3).
A randomized controlled study in patients with metatarsalgia related to Morton‘s neuroma (4) found that ESWT was significantly superior over placebo with regard to pain relief (visual analog scale [VAS] 64 to 42 after 1 week and to 36 after 4 weeks of treatment) and the American Orthopedic Foot and Ankle Society (AOFAS) scores within 4 weeks (67 points versus 76 points).
In the light of the above mentioned evidence, we would like to draw attention to this noninvasive treatment option for plantar heel pain and the new reimbursement situation with the GKV.
Prof. Dr. med. Karsten Knobloch, FACS
Präsident deutschsprachige internationale Gesellschaft für ESWT (DIGEST), Hannover, Germany
Dr. med. Martin Ringeisen
Generalsekretär deutschsprachige internationale Gesellschaft für ESWT (DIGEST), Augsburg, Germany
PD Dr. med. Jörg Hausdorf
Leiter des AK Stoßwelle der DGOOC, München, Germany
Prof. Dr. med. Ludger Gerdesmeyer
Vorstand deutschsprachige internationale Gesellschaft für ESWT
(DIGEST), Kiel, Germany
Conflict of interest
Prof. Knobloch received reimbursement of participation fees and travel and accommodation expenses as well as fees for the preparation of scientific meetings from Storz Medical.
The remaining authors declare no conflict of interest.
|1.||Gutteck N, Schilde S, Delank KS: Pain on the plantar surface of the foot. Dtsch Arztebl Int 2019; 116: 83–8. VOLLTEXT|
|2.||Gollwitzer H, Saxena A, DiDomenico LA, et al.: Clinically relevant effectiveness of focused extracorporeal shockwave therapy (ESWT) in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am 2015; 97: 701–8 CrossRef MEDLINE|
|3.||Li S, Wang K, Sun H, et al.: Clinical effects of extracorporeal shockwave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97: e13687 CrossRef MEDLINE PubMed Central|
|4.||Seok H, Kim SH, Lee SY, Park SW: Extracorporeal shockwave therapy in patients with morton’s neuroma. A randomized, placebo-controlled trial. J Am Podiatr Med Assoc 2016; 106: 93–9 CrossRef MEDLINE|